Best & Worst Places to Practice 2019: Where Physicians Can Thrive
Medscape ranked all 50 states on the basis of 14 key criteria, to identify locales where physicians can thrive both in their practices and in the broader community. Five metrics—burnout, happiness at work, unhappiness at work, happiness outside of work, and unhappiness outside of work—come from physicians' own assessments of their work-life situations.
Three measures pertain to the regulatory and fiscal environment affecting physicians in each state. Five metrics gauge the overall performance of the state's healthcare system. Finally, each state was ranked on its overall livability. (For details on the sources used, see "Criteria and Sources.")
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
1. Minnesota
The outdoors, culture, and affordability all add to this state's desirability. Minnesota ranked among the top for all of the 14 criteria measured. Average physician compensation is $322,000. The majority of doctors say they are happy both at and outside of work. Physicians in Alaska and Minnesota reported the lowest levels of burnout (36%) in the nation. Minnesota has an outstanding health system and ranks second on overall livability.
Suggested community: Woodbury
Last year, Money magazine chose this suburb as one of the top 10 places to live in the United States. Woodbury is located in Washington County, which U.S. News and World Report and the Aetna Foundation say is the nation's 15th healthiest community.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
2. Iowa
Iowa boasts an easier pace of life, with a strong focus on family. Iowa has the country's lowest unemployment rate (2.4%). Physicians report low levels of burnout (38% vs national average of 44%), and the state ranks high for access and affordability of care. A Medicaid expansion state, Iowa has the second lowest rate of uninsured persons (4.7%) in the nation and ranks first in overall livability.
Suggested community: Iowa City
A Big Ten university town, many of Iowa City's amenities rival those of much larger Midwestern cities. Home to the world-renowned Iowa Writers' Workshop, Iowa City is one of only two US cities designated as a UNESCO City of Literature.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
3. Wisconsin
Varieties of cheese, a legendary music festival, and a mecca for young professionals help make Wisconsin a desirable state to live in. Wisconsin doctors report a slightly lower level of burnout than the national average and a high level of happiness on the job. Thanks to the state's low cost of living, the average physician compensation of $320,000 goes a long way. Malpractice payouts for claims against physicians were among the lowest in the nation.
Suggested community: Madison
Madison is a vibrant college town and the state capital. Located on an isthmus between Lakes Mendota and Monona, Madison ranks as one of the best cities for recent college grads. There's plenty of opportunity for boating, fishing, ice skating, and other outdoor sports. Unemployment was just 2.6% in January 2019.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
4. Utah
National parks, information technology, skiing, and cattle ranching are some of the attractions of Utah. The burnout rate for physicians is below the national average. Utah's health system scores in the top three spots for avoidable hospital use and costs, healthy lives, and low disparity of care. The state ranks third in terms of overall livability indicators and has a low rate of adverse actions against physicians.
Suggested community: Orem
Money magazine ranks Orem, which is located just north of Provo and touts itself as "Family City USA," as one of the 20 best places to live in the nation. Orem's unemployment rate in January 2019 was just 2.6%.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
5. Hawaii
Hawaii, known for its lush beauty, ranks better than any other state in terms of access and affordability of healthcare. The state is low in its rate of adverse actions against physicians, and the second lowest for malpractice payouts per capita. But Hawaii's tropical appeal comes at a price. The state has the highest cost of living, so average physician compensation doesn't stretch as far as it would elsewhere.
Suggested community: Kapaa
A beach community on the island of Kauai (the Garden Island), Kapaa has been the backdrop for many Hollywood films. It is small and more remote than the Big Island but boasts a strong educational system. However, the median home price tops $750,000.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
6. Washington
Washington is the leading producer of apples, pears, and other fruit, and has a fairly large wild horse population. Doctors who are happy at work are the majority. Off the job, Washington doctors are almost six times more likely to say they're happy than not, and they're slightly less burned out than physicians in other states. Washington has a relatively expensive cost of living, but the state ranks well in terms of health system performance and overall lifestyle indicators.
Suggested community: Richland
Located at the confluence of the Yakima and Columbia rivers, Livability.com ranks Richland one of its best places to live. Richland offers good schools, many housing options, and a socially engaged population.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
7. Nebraska
The state is known for friendly people, a great zoo, state fairs, and football. Nebraska physicians are among the least burned out in the nation. Nebraska doctors also reported the second highest level of happiness both at work and outside of work. At 2.8%, the state's unemployment rank in January was among the lowest in the country. Average physician compensation of $324,000 is particularly high in light of the state's low cost of living.
Suggested community: Bellevue
French for "beautiful view," Bellevue is an easy commute to Omaha. Overlooking the Missouri River, Bellevue is located in Sarpy County, which ranks as the state's healthiest county.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
8. South Dakota
The state features natural beauty and such attractions as Mount Rushmore and Badlands National Park. Doctors in South Dakota are among the happiest at work of any in the nation, and among the least burned out (37% vs 44% average for all states). They also are among those receiving the highest average compensation. Because the state's cost of living is slightly below average, those dollars go a long way. Healthcare in the state ranks above average for most metrics, as does livability.
Suggested community: Sioux Falls
Sioux Falls is the largest city in South Dakota. Residents love Falls Park, with its flowing waterfalls, and the city's variety of attractions. Its growth is outpacing the national average, according to Money. Healthcare is the biggest industry, but several major financial services companies also have operations in the area.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
9. Massachusetts
Beaches, mountains, cities, and history all make Massachusetts noteworthy. The state has a low rate of adverse actions against doctors. The state's health system is a top performer, and Massachusetts ranks among the top for overall quality-of-life considerations. Although doctors in the state are generally happy at work and almost seven times more likely to say they're happy outside of the office, the state ranks high for burnout. Massachusetts has good health systems, but physician density is high—there are more primary care physicians per state resident than in any other state.
Suggested community: Newton
Money rates Newton, an affluent community in a lovely suburban setting near Boston, number 12 on its best places to live. Niche.com gives it an A+ "good for families" rating.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
10. Vermont
Many people are enamored with the country life of Vermont. Although Vermont doctors enjoy the highest level of outside-of-work happiness (78%), nearly two thirds (64%) say they're burned out. Vermont has invested $620 million in OneCare Vermont, an accountable care organization that emphasizes preventive care, care coordination, and capitation payments. Vermont doctors are generally well paid, and malpractice rates are fairly low.
Suggested community: Colchester
Located on the eastern shore of Lake Champlain in the heart of the Green Mountains, Colchester is an outdoor lover's paradise offering easy access to the University of Vermont, with lower housing prices than in nearby Burlington.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
11. North Dakota
If you can deal with some challenging weather, North Dakota can offer beautiful scenery, friendly people, and a very tax-friendly environment. It's considered a good state for economic growth. The malpractice environment is favorable—payouts for claims against physicians were very low in 2018. North Dakota ranks fourth in terms of overall livability, and unemployment was just 2.5% in January 2019.
Suggested community: Bismarck
Bismarck, the state capital and a regional healthcare hub, offers an affordable cost of living, great job opportunities, and an infrastructure that makes it easy to get around. It's a bustling city with spectacular scenery.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
12. Idaho
Idaho has lots of outdoor recreation and music festivals, and some interesting museums and attractions. It is considered one of the safest states in the nation. For physicians, average compensation in Idaho is $320,000. Idaho ranks somewhat low in terms of access, but high for avoidable hospital use and costs, healthy lives, and low disparity of care. Nearly one half (49%) of doctors say they're burned out, yet very few (5%) say they're unhappy at work.
Suggested community: Boise
The Treasure Valley area is full of opportunity and has added about 48,000 new jobs across all sectors in the past 5 years, according to the East Idaho Business Journal. Boise boasts Idaho's top-ranked school district.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
13. New Hampshire
The state has lively cities, plentiful national forests, and snowy mountains. Doctors here are less likely to suffer from burnout than the national average, and outside of work, they are among the happiest in the nation. New Hampshire ties with Iowa for having the lowest unemployment rate in the country, and the state is in the top 20% for median household income. Less than 6% of the population is uninsured.
Suggested community: Nashua
Nashua was the first city to be named Money's "Best Place to Live" more than 30 years ago and is the only city to claim that honor twice. Many of the town's historic mills have been converted into apartments, studios, and workspaces.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
14. Colorado
Colorado residents love the state's mountains, fresh air, skiing, arts, and culture. Many also consider the legal marijuana a plus. Colorado doctors are more than three times as likely to say they're happy, rather than unhappy, at work and almost five times as likely to be happy off the job. The state health system ranks in the first or second quintile for all metrics except access and affordability (26th), but the rate of adverse actions against physicians is somewhat high.
Suggested community: Highlands Ranch
Located south of Denver, this well-heeled Colorado suburb has landed on Money's "Best Places to Live" list five times in the past decade and made the top 10 in 2018. There are great mountain views, lots of parks, and good schools, and it's considered a wonderful place to raise children.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
15. Montana
The scenery is spectacular, and Montana is a very affordable state. Many celebrities have their summer home in Montana. Montana had the lowest rate of adverse actions against doctors last year. Most doctors say they're happy outside of work, but at work they're ambivalent, and burnout is above average. Montana ranks in the second and third quintile for most measures of health system performance. The state ranks 45th in the number of primary care physicians per 100,000 residents.
Suggested community: Billings
Nicknamed "Montana's Trailhead," Livability.com calls Billings one of the top places to live for its casual Western vibe. The largest city in Montana and home to Montana State University, Billings has its own orchestra and international airport.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
16. Delaware
Delaware is a very tax-friendly state, with no state sales tax, no personal property taxes, and miles of ocean and bay coastline. Delaware ranks sixth in terms of prevention and treatment, although its health system is a middling performer. Malpractice claims against Delaware doctors last year were in line with the national average. The average physician compensation of $307,000 spends like less because the state has an above-average cost of living, and nearly half of Delaware physicians say they're burned out.
Suggested Community: Hockessin
A bedroom community just 20 minutes from Wilmington and 50 minutes from Philadelphia, Hockessin boasts one of the top educational systems in the state.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
17. North Carolina
Art, crafts, culture, and hospitality are staples of this state. North Carolina physicians are slightly less likely to suffer from burnout than physicians in general, and most say they are happy outside of work. At $320,000, average compensation stretches a little further given the state's below-average cost of living. The incidence of adverse actions taken against physicians was well below the national average.
Suggested community: Cary
A safe, friendly town with proximity to the Research Triangle of Durham, Raleigh, and Chapel Hill, Cary made Money's "Top 10 Best Places to Live" list in 2018. The magazine calls it quieter and more suburban than nearby Raleigh, with fantastic job growth, particularly in the tech sector.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
18. Oregon
Mild winters, plenty of forest, and the home place of major companies, Oregon ranks 16th in terms of overall livability. Burnout for Oregon physicians is about the same as the national average, as is physician compensation ($313,000). Measures of the state's healthcare system fall into the second quintile, with the exception of avoidable hospital use and cost, where the state excels, and prevention and treatment, where it lags.
Suggested community: Corvallis
Surrounded by majestic mountains and the picturesque Willamette Valley, Corvallis was one of Livability.com's "10 Best College Towns" in 2017. It has beautiful wineries and Oregon State University.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
19. Virginia
Between the Blue Ridge Mountains, Southern hospitality, and a growing and diverse population, Virginia has many attractive features. Burnout among Virginia doctors is less than average, and they're more than twice as likely to say they're happy at work rather than unhappy. Malpractice payouts in claims against doctors were below the national average. Healthcare measures in the state generally ranks in the second or third quintile. Overall, the state has an above-average livability score.
Suggested community: Ashburn:
Ashburn claimed the second highest spot on Money's "Best Places to Live" list last year. The town, located about an hour and a half from Washington, DC, is a technology hub that offers lots of wineries, breweries, and outdoor activities.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
20. Maine
Clean mountain air, blueberries, and lobsters are among Maine's charms. Maine's doctors are among the least burned out in the nation and are happier at work than those in any other state. Still, the incidence of adverse actions against doctors is high. Average physician compensation of $324,000 puts Maine somewhat above average. The state's healthcare system ranked in the top two quintiles for four out of five measures.
Suggested community: South Portland
Money called South Portland the best place to live in Maine in 2017 because of its bustling food and bar scene, a thriving economy, and affordable cost of living relative to the rest of the state.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
21. New York
New York doctors are more likely to describe themselves as happy at work than physicians in general, and burnout is slightly below the national average. Adjusting for New York's high cost of living puts the average compensation ($301,000) relatively low among the states. Although malpractice payouts for claims against physicians were the highest per capita of any state last year, the incidence of adverse actions against physicians was small. The Commonwealth Fund ranked New York first for healthcare improvements in 2018.
Suggested community: Albany
Livability.com named the New York state capital among its top 100 places for 2019. Among the selling points: superior healthcare and health education.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
22. Rhode Island
Rhode Island's health system performs well in terms of access and affordability and prevention and treatment. Off the job, Rhode Island docs are thriving. They're nine times more likely to be happy than not. Average compensation ($318,000) is about in the middle range.
Suggested community: Kingston
Kingston is a lovely suburb of Providence, with a college campus. Niche.com gives Kingston an A+ rating and recommends it as a great place for families.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
23. Maryland
Maryland doctors have a below-average rate of burnout and are more likely than doctors in other states to say they are both happy at work and outside of work. The state comes in 13th in terms of livability. Average physician compensation ($307,000) in Maryland is lower than average, and the state has a steep cost of living.
Suggested community: Ellicott City
Ellicott City, part of the Baltimore metropolitan area, landed the number four spot on Money's "Best Places to Live" list last year. The town has plenty of restaurants, cultural and entertainment options, shops, and historic sites.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
24. New Jersey
From the Jersey Shore to a section of the Appalachian Trail, New Jersey's varied terrains and neighborhoods appeal to many physicians. New Jersey had a low incidence of adverse actions against doctors last year, and the health system ranks near the middle. Average physician compensation of $315,000 ranks in the bottom quintile after adjusting for cost of living. Although the share of New Jersey physicians who say they are burned out (46%) is above the national average, most New Jersey physicians describe themselves as happy outside of work.
Suggested community: Parsippany-Troy Hills
Money recommends Parsippany-Troy Hills to New York commuters looking for a solid community in which to raise their families.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
25. California
California is a generally expensive state, but the weather, culture, and unique attractions hold a consistent appeal for residents. California's state health system performs well in the "healthy lives" category, which includes measures of premature death, health status, and health risk behaviors, but poorly in the prevention and treatment category. California doctors suffer an average rate of burnout, are twice as likely to be happy rather than unhappy at work, and are more than five times as likely to be happy than not off the job.
Suggested community: Dublin:
Money calls Dublin, located about 20 miles southeast of Oakland, "an ideal city to settle down in." It has an average of 260 sunny days annually and a reputation as one of the fastest-growing cities in California. Dublin is an easy 1-hour commute to San Francisco by public transportation. Median home value is more than $900,000, according to Zillow.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
Worst States
Although we've used consistent metrics, "best" and "worst" are often subjective terms. Some states may pose more challenges for doctors, yet physicians living and working there may consider them great places to live and practice.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
1. Kentucky
Half of Kentucky's doctors say they're burned out. About 1 in 5 are happy on the job, but about the same number aren't. Malpractice payouts for claims against doctors were above the national average, and the state health system ranks in the bottom quintile. Fiscal instability, weak employment, and a lackluster business environment put the state's livability score in the bottom quintile as well. On the upside, most Kentucky doctors say they're happy outside of work.
Suggested community: Bowling Green
Money ranks Bowling Green, Kentucky's third largest city, the best place to live in the state in 2018, noting that Moody's Analytics predicts a 7.4% increase in jobs by 2022. Bowling Green has a hometown feel.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
2. West Virginia
West Virginia placed 47th on the Commonwealth Fund's report card for health systems in 2018. On a per capita basis, payouts for claims against physicians were about 75% higher than the national average. West Virginia's unemployment rate in January was 5.2%, the second worst behind Alaska. On the upside, the Commonwealth Fund found West Virginia was among the states to show the most healthcare improvement in 2018.
Suggested community: Morgantown
Morgantown is home to West Virginia University, the Monongalia Arts Center, Core Arboretum, and a beautiful riverfront park.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
3. Louisiana
Louisiana ranked lowest on the livability scale and ranks among the five poorest-performing states for four out of five state health system measures. Relative to the size of the state's population, malpractice payouts for claims against physicians were well above the national average last year.
Suggested community: Metairie
Money is enthusiastic about Metairie, located just 15 minutes from New Orleans. Household incomes in Metairie are well above the state average, and the town has a bustling nightlife.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
4. Nevada
Nevada scored lower than any other state in the prevention and treatment category and near the bottom for access and affordability. The rate of adverse actions against physicians was very high. Nevada doctors were more likely than those in any other state to say they are unhappy at work and have a slightly higher incidence of burnout (45%).
Suggested community: Henderson
If you favor a community with a desert climate and job growth, Nevada's second largest city, located just outside Las Vegas, may be for you. Henderson has several planned suburban developments, as well as casinos.
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
5. Oklahoma
The Commonwealth Fund ranked Oklahoma's health system in the bottom 20% for all five categories in 2018. Healthcare in Oklahoma's ranked low on U.S. News and World Report's livability scorecard as well, and the state's 2018 teacher's strike highlighted education funding shortfalls. But Oklahoma doctors report a lower than average rate of burnout, and average physician compensation of $337,000 is above the national average.
Suggested community: Tulsa
Tulsa made Livability.com's top 100 list for 2019 for its affordability, "under-the-radar cool," and "unbelievable arts scene that rivals cities twice its size." The city also has many parks and hiking trails, as well as a noteworthy art museum.
Related Content on Medscape
Medscape Physician Compensation Report 2019
Medscape National Physician Burnout, Depression & Suicide Report 2019
Medscape Physician Lifestyle & Happiness Report 2019
Medscape Ethics Report 2018: Money, Romance, and Patients
Best & Worst Places to Practice 2019: Where Physicians Can Thrive
Criteria and Sources
Overall rank was based on combining the following state-based criteria, ranked from 1 (best) to a possible worst of 50: average physician compensation adjusted for cost of living; malpractice payouts in claims against physicians relative to the size of the state's population; and incidence of adverse actions against doctors relative to the physician population in the state.
Each state was also ranked on its overall livability, an umbrella category encompassing the state of healthcare, education, the economy, opportunity, infrastructure, crime and corrections, and fiscal stability in each of the 50 states. Because livability affects so many aspects of life, the category was weighted.
Sources: Burnout and Happiness
Kane L. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape News & Perspective. January 16, 2019. Source
Martin KL. Medscape Physician Lifestyle and Happiness Report 2019. Medscape News & Perspective. January 9, 2019. Source
Sources: Regulatory and Fiscal Environment
Kane L. Medscape Physician Compensation Report 2019. Medscape News & Perspective. April 10, 2019. Source
Cost-of-living adjustments were made on the basis of the Missouri Economic Research and Information Center's (MERIC) 2018 Cost of Living Data Series. MERIC derives state indices by averaging the indices of cities and metropolitan areas in the state that participate in the Council for Community & Economic Research survey. Source
Malpractice payouts per capita. Estimated malpractice payouts per capita were based on malpractice payouts in claims filed against physicians divided by state population. Payout data come from Singh H. National Practitioner Data Bank: adverse action and medical malpractice reports (1990-2018). Source
Payout data were divided by population data from the Kaiser Family Foundation estimates based on the Census Bureau's American Community Survey (ACS), 2008-2017. Population data may differ from population estimates published annually by the Census Bureau because they are restricted to the civilian, noninstitutionalized population from whom ACS collects data. Source
Adverse actions against physicians. This was defined as the number of adverse actions against physicians in 2018 by state compared with the number of physicians in the state. Singh H. National Practitioner Data Bank: adverse action and medical malpractice reports (1990-2018). Source
Sources: State Health System Performance
The Commonwealth Fund 2018 Scorecard on State Health System Performance evaluates 43 performance indicators grouped into four dimensions. Source
Metrics consist of:
Access and affordability. Seven indicators, including rates of insurance coverage for children and adults, individuals' out-of-pocket expenses for health insurance and medical care, cost-related barriers to receiving care, and dental visits.
Prevention and treatment. Sixteen indicators, including measures of receiving preventive care and needed mental healthcare, as well as measures of quality in ambulatory, hospital, postacute, and long-term care settings.
Potentially avoidable hospital use and cost. Ten indicators of hospital and emergency department use that might be reduced with timely and effective care and follow-up care, as well as estimates of per-person spending among Medicare beneficiaries and working-age adults with employer-sponsored insurance.
Healthy lives. Ten indicators measure premature death; health status; health risk behaviors, including smoking and obesity; and tooth loss.
Disparity. This metric evaluates performance differences within states associated with individuals' income level for a subset of 19 indicators that span the other four dimensions of performance.
Sources: Overall Livability
Metrics in seven classifications are used to rank life in the state. Classifications are healthcare, education, economy, opportunity, infrastructure, public safety, fiscal stability and quality of life. U.S. News and World Report Best State Ranking. Source
Additional State and Community Sources
Bureau of Labor Statistics. Local area unemployment statistics, seasonally adjusted. January 2019. Source
U.S. Census Bureau. Percentage of the population without health insurance coverage by state 2013, 2016, and 2017. Source
McCann A. 2019's tax burden by state. 2018. WalletHub. April 2, 2019. Source
U.S. News and World Report; Aetna Foundation. Healthiest Communities Rankings 2019. Measuring health and wellness across the U.S. using 81 metrics November 20, 2018. Source
Mishkin S, Akhtar A, Bhardwaj P. This is the best place to live in every state. Money Magazine. December 17, 2018. This annual list selects the best community in each state on the basis of economic growth, affordability, and quality of life. Source
The best places to live in America. Money Magazine. This list assesses communities of at least 50,000 people according to 70 data points relating to economy, cost of living, diversity, education, income, housing, crime, amenities, and ease of living. Source
Livability.com. 2019 top 100 best places to live. Selections are based on more than 40 data points, including amenities, demographics, education, economy, health care, housing, social and civic capital, and transportation and infrastructure. Source
McCann A. Best cities for jobs. WalletHub. January 3, 2019. Source
Trimble M. The 10 best U.S. states for education. U.S. News and World Report. February 27, 2018. Source
Niche.com. 2019 best places to live in America. Source
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